The most extraordinary conference I’ve ever been to: Dotmed2014

Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

At Dotmed2014 “The creative medical conference” everyone present seemed to be just a little bit different, both on the stage and in the audience. There were artists, musicians, poets, novelists, doctors and patients. Muiris Houston, doctor, journalist, and joint convenor of the conference, said it was designed to explore that space between medicine and humanity. But, it was also empowering, entertaining, stimulating and mind bending.

When she saw the blood on the glove she knew it was time to create a fuss. Not everyone does a rectal examination on their dad, but his blood pressure was dropping and the medical staff were not taking enough notice and someone had to look for a cause. Stories grab attention and when Dr Louise Aronson from UCSF told a gripping story of her father’s stay in hospital she showed that doctors, just like patients, respond well to narratives. For those of involved in public medical communication Aronson said, “the communication ecosystem has changed” and she gave five tips:

Marie Ennis-O'Connor, health blogger and breast cancer survivor, also reminded us that for each patient, their illness has a story and meaning. To understand the narrative in illness is to know what it is to be human.
But, if stories grab attention, it was a patient’s comment during the question and answer session that made the biggest impression, when she said, “if a consultant comes into your room, sits down beside you, and takes your hand in his, you know you’re fucked”.

Guiding a patient’s health care is now more akin to the role of an astronaut in a space shuttle than the skills of an early pilot flying a plane, according to Dr Marc Triola from NYU School of Medicine. Doctors and patients have access to so much information in the digital age that decision making is incredibly complex and needs teamwork and safety systems. In medical education alone, there is an enormous range of free online education and, medical education has changed so much that in his medical school they have moved histology teaching completely away from microscopes to online, and teach integrated 3d anatomy with iPads, cadavers, and Netters diagrams.

The conference included a “Dragon’s Den” for medical innovations where new technology developers made their pitch. These included a teaching and learning aid for medical students, an app to locate the nearest first responder (wittily described as Tindr, but for death) and an app to encourage physical activity. But, technology has bypassed many hospital communication systems and one pitch made that particularly clear: Look at any doctor's phone and you will see not only pictures of their spouse, children, house or garden but someone’s EKG, someone else’s barium enema, or an infected wound - doctors have been using the photo facility on their phones to consult with colleagues and seek second opinions. Instead of using clunky internal hospital information systems, they are using cameras and social media platforms to share information. But these are not secure.

Artist Emma Barnard’s work showed the masks that doctors and patients wear. Her hospital collaboration was a stark reminder to the medical profession of the invisible patient. How often have we referred to patients as bed 14, or by their disease- a good case of ...[whatever]? For me, her most dramatic image was that of a patient whose face, and identity, was obscured by a bar code. In another project, she photographed patients and asked them to write or draw their feeling on their portrait. Regardless of the condition, patients sitting waiting in the clinic often think of death and, one of the apparently most relaxed patients, drew himself as a man falling off a cliff.

Kevin Barry, Impac Award-winning author, suggested that the Internet has made us neurologically damaged - that we may never be able to read normally again. We have developed a constant nervous tension because of online use checking emails, google, skipping for article to article online with a tiny attention span. The skin of anxiety. But, he did express some hope for the future, in that some young people were moving away from online addiction and that, perhaps, the Internet has become a bit of a “dad” thing. And, in Louse Manifold's film, narrated by Kevin Barry, I learned about Cotard’s delusion (where people believe they are dead), a medical reference that Beckett used in his early literary works.

ZDoggMD, aka Dr Zubin Damania, Rapper, doctor, and founder of Turntable Health, described how in response to his disillusionment with 80hrs a week medical on-call, he used very basic technology to make a rap video about checking for testicular cancer, based on Michael Jackson song. Later, his irreverent approach to health communication ultimately allowed him to attract sufficient philanthropic support to create an entirely new model of health care in Las Vegas called Turntable health.

Tom Lynch, Irish American poet and undertaker, who described his chairperson’s introduction as tastefully hyperbolic and faintly obituarial, entertained us with his stories of death. He described how doctors spend their lives trying to keep the sky from falling…but, he said, the sky is falling. Reflecting on his professional work as an undertaker... the corpse may not care but they do still matter- and they have people to whom they matter. But we seem to have banished the dead from their own obsequies - the dead are the same as they always were. There is a continuum between life and death shared by doctors and undertakers. One difference, however, between medicine and his job was, he said, that when you dial the undertaker they answer the phone!